Health care research has been ?chasing the longevity curve? for the past half-century. As longevity has increased in the population, research has lagged behind, resulting in limited evidence for clinical decision- making for those reaching late old age. As older adults survive into their 90s, in other words, they enter a chasm of evidence-free medical care. The population aged 90 years and older, who has high health care needs, is projected to more than quadruple from 2010 to 2050. Cardiovascular disease is the most common cause of morbidity and mortality in this population, and cardiovascular health means more than simply the prevention of cardiovascular events. Subclinical vascular disease that affects the brain can reduce physical or cognitive function. Vascular and heart disease can lead to mobility impairments and functional limitations. These reductions in cognitive and physical functioning can severely restrict independence and lead to institutionalization. We propose that early old age (<75 years) is a critical period of risk accumulation, and exposure to traditional cardiovascular risk factors during this time will influence cardiovascular and functional health in late old age. The participants in the Cardiovascular Health Study (CHS) have been uniquely well characterized with respect to early old age and thus represent an unprecedented opportunity to answer the question of why some older adults are able to maintain functional health and remain free of cardiovascular disease well into their 90s. We propose to create a synthetic cohort of nearly 2,000 CHS participants who have lived to age 90 or older. The objective of this application is to identify factors in early old age that may provide targets for preservation of cardiovascular and functional health into late old age. We hypothesize that those with normal systolic blood pressure, low LDL-cholesterol levels, high HDL-cholesterol levels, and optimal fasting glucose levels in early old age (<75 years) will be more likely to have better cardiovascular and functional health at age 90 than those with suboptimal levels of these risk factors. Importantly, we hypothesize that these associations will be stronger than the associations of these same risk factors measured in late old age. We also propose that novel risk factors that reflect accumulated risk, cystatin C, a marker of kidney function, and NT-pro-BNP, a marker of cardiac stress, will be associated with cardiovascular and functional health at age 90. Finally, we will provide descriptive data on cardiovascular events and functional health among adults aged 90 and older. The proposed research will characterize the health status of nonagenarians which is important for planning for the needs of this population. More importantly, we will provide insight into critical periods of risk accumulation. Traditional risk factors - blood pressure, lipids, and blood glucose - are pharmacologically modifiable, therefore the findings of our research will inform the design of future trials to identify the optimal timing for risk factor treatment. Our long-term goal is to inform practice guidelines that will optimize cardiovascular and functional health among long-lived adults who reach age 90 or older.